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General NPI Number Information
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NPI Number | 1114186616
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Entity Type | Organization
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Legal Business Name | UROLOGY CLINICS OF NORTH TEXAS, PLLC
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 6124 W PARKER RD SUITE 434
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City | PLANO
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State | TX
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Zip | 75093-8122
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Country | US
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Telephone | 214-691-1902
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Fax | 214-987-1845
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Provider Business Mailing Address
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Address Line | 1650 REPUBLIC PKWY STE 150
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City | MESQUITE
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State | TX
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Zip | 75150-6917
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Country | US
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Telephone | 214-692-8262
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Fax | 214-696-4190
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Authorized Official
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Title or Position | CEO
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Name | JERRI D WILSON
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Credential |
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Telephone | 214-691-1902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | K3232
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | G9345
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | M0918
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License Number State | TX
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